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Adult II 2015Adult II 2015
Emergency Medications
National EMS Education Standard CompetenciesNational EMS Education Standard Competencies
Emergency Medications
• Names
• Effects
• Indications
• Routes of administration
• Dosages for the medications administered
National EMS Education Standard CompetenciesNational EMS Education Standard Competencies
Emergency Medications (cont’d)
• Actions
• Contraindications
• Complications
• Side Effects
• Interactions
AHA Classification of Recommendations and Level
of Evidence
AHA Classification of Recommendations and Level
of Evidence
• Class I− A treatment should be administered.
• Class IIa− It is reasonable to administer treatment.
• Class IIb− Treatment may be considered.
AHA Classification of Recommendations and Level
of Evidence
AHA Classification of Recommendations and Level
of Evidence
• Class III− Treatment should NOT be administered.
− It is harmful, not helpful.
• Class Indeterminate− Research is either beginning or continuing on
this treatment.
− Cannot be recommended for or against
Medication ListingsMedication Listings
• Name of medication− And other common names
• Class− How the medication is classified compared to
other medications
Medication ListingsMedication Listings
• Mechanism of action− The way a medication produces the intended
response
• Indications− Circumstance that shows cause or warning of
disease
• Contraindications− Any condition that renders some particular line
of treatment improper or undesirable
Medication ListingsMedication Listings
• Adverse reaction/side effects− An abnormal or harmful effect to an organism
caused by exposure to a chemical
• Drug interactions− Any potential effects a medication may have
when administered with or in the presence of something else in the patient’s system
Adenosine (Adenocard)Adenosine (Adenocard)
• Classification:
• anti arrhythmatic, diagnostic
agent
• Mechanism of action− Slows conduction through
the AV node
− Can interrupt reentrant pathways
− The drug of choice for reentry SVT
• Indications− Most forms of stable
narrow-complex SVT
• Contraindications− Bronchoconstrictive or
bronchospastic lung disease
• Adverse reactions− Generally short duration and
mild
• Considerations− Evaluate elderly for signs of
dehydration
− Dose:by rapid IV bolus only given over 1_2 seconds administered directly into a vein or as proximal as possible ; follow with a rapid saline flush .
Albuterol (Proventil, Ventolin)
Albuterol (Proventil, Ventolin)
• Mechanism of action− Results in smooth-
muscle relaxation in the bronchial tree
• Indications− Treatment of
bronchospasm in patients with COPD/asthma)
• Contraindications− Hypersensitivity
reactions to albuterol
• Adverse reactions− Often dose-related
and include headache, fatigue, lightheadedness, irritability, restlessness
• Considerations− Pregnancy safety:
Category C
− May precipitate angina pectoris and dysrhythmias
Alteplase, Recombinant (Tissue Plasminogen Activator
or rTPA, Activase)
Alteplase, Recombinant (Tissue Plasminogen Activator
or rTPA, Activase)
• Classification: Thrombolytic agent
• Mechanism of action− Restores perfusion
• Indications− Acute myocardial infarction,
STEMI, massive pulmonary emboli, acute ischemic cerebrovascular accident
• Contraindications− Active internal bleeding− Recent surgeryDose: 100mg IV over 2 hr,
followed immediately by heparin therapy .
• Adverse reactions− Intracranial bleeding,
reperfusion dysrhythmias, chest pain, hypotension, GI bleeding, nausea, abdominal pain
• Considerations− Monitor vital signs
closely.
− Observe for bleeding.
Amiodarone (Cordarone, Pacerone)
Amiodarone (Cordarone, Pacerone)
• Classification antiarrhythmatic
• Mechanism of action− Delays repolarization and
increases the duration of action potential
• Indications− Ventricular fibrillation
• Contraindications− Known hypersensitivity to
amiodarone or iodine− Cardiogenic shockDose:1000mg IV over 24hours,150
mg loading dose over 10min,followed
− Over 6 hr at rate 1mg/min− For maintenance infusion
540mg at 0.5 mg / min over 18 hr .
• Adverse reactions− Dizziness, fatigue,
malaise
− Congestive heart failure
• Considerations− Pregnancy safety:
Category D
− Monitor patient for hypotension.
Aspirin (ASA)Aspirin (ASA)
• Classification:
antiplatelet
• Mechanism of action− Prevents platelets from
clumping together and forming emboli
• Indications− New onset chest pain
suggestive of acute myocardial infarction
• Contraindications− Relatively contraindicated in
patients with active ulcer disease or asthma
• Adverse reactions− Bronchospasm,
anaphylaxis, wheezing in allergic patients, prolonged bleeding
• Considerations− Pregnancy safety:
Category D
− Use cautiously with impaired renal function .
Atropine SulfateAtropine Sulfate
• Classification:
• Parasympathetic,Anticholinergic
• Mechanism of action− Increases heart rate in life-
threatening bradydysrhythmias
• Indications− Hemodynamically unstable
bradycardia
• Contraindications− Tachycardia, hypersensitivity
Dose:
for bradycardia 0.4mg to1mg (up to 2 mg )IV every 1-2 hr as needed .
• Adverse reactions− Drowsiness, confusion,
headache, tachycardia, palpitations
• Considerations− Pregnancy safety: Category
C
− Moderate doses may cause pupillary dilation.
Calcium GluconateCalcium Gluconate
• Classification:
• Electrolytes
• Mechanism of action
− Helps maintain cardiac function
• Indications
− Hyperkalemia, hypocalcemia
• Contraindications
− Ventricular fibrillation, digitalis toxicity, hypercalcemia
− Dose :infusion slowly ,0.5ml-2ml/min, (500mg /kg/day IV given in divided
Doses.
• Adverse reactions− Syncope, cardiac
arrest, dysrhythmia, bradycardia
• Considerations− Pregnancy safety:
Category C
− Do not administer by IM or SQ,stop infusion if patient complains of discomfort; resume when symptoms disappear .
Clopidogrel (Plavix)
Clopidogrel (Plavix)
• Classification:Antiplatelet
• Mechanism of action− Inhibits platelet aggregation
by blocking Adenosine diphosphate receptors on platelets(ADP), preventing clumping of platelets.
• Indications
− Acute coronary syndrome
− Substitute for aspirin in patients unable to take aspirin
Dose: recent MI,stroke 75mg daily
ACS (Acute Coronary Syndrome )300mg PO loading dose , then 75mg/day with aspirin .
• Contraindications− Active GI bleeding,
intracranial hemorrhage
• Adverse reactions− Severe neutropenia
− Hemorrhaging
• Considerations− Pregnancy safety: Category
B
− Often given with other anticoagulants
Dexamethasone Sodium Phosphate (Decadron)
Dexamethasone Sodium Phosphate (Decadron)
• Classification: corticosteroid ,Hormone
• Mechanism of action− Suppresses acute and
chronic inflammation
• Indications− Anaphylaxis, asthma, spinal
cord injury,cerebral edema associated with brain tumor ,craniotomy, or head injury .
• Contraindications− Hypersensitivity, use
caution in suspected systemic sepsis
• Adverse reactions− Headache,
restlessness, euphoria, psychoses
• Considerations− Pregnancy safety:
Category C
− Protect medication from heat. Toxicity and side effects occur with long-term use.
Diazepam (Valium and Others)
Diazepam (Valium and Others)
• Classification :• Benzodiazepine, Anxiolytic,
Antiepileptic, Skeletal muscle relaxant (centrally acting ).
• Mechanism of action− Raises the seizure
threshold; induces amnesia and sedation
• Indications− Acute anxiety states and
agitation, acute alcohol withdrawal
• Dose :Status epilepticus5-10mg by slow IV. May repeat q 5-10 min to total dose 30mg .
• Contraindications− Hypersensitivity, narrow-
angle glaucoma
− Adverse reactions− Dizziness, drowsiness,
confusion, headache
• Considerations− Pregnancy safety: Category
D
− Short duration for anticonvulsant effect
− Reduce dose by 50%
in elderly patients.
Digoxin (Lanoxin)Digoxin (Lanoxin)
• Classification :
Cardiac glycoside ,Cardiotonic
• Mechanism of action− Increases force of
myocardial contraction
• Indications− Congestive heart failure,
reentry SVTs, ventricular rate control in atrial flutter and atrial fibrillation
• Dose:evaluate patient carefully to determine the appropriate dose
loading dose 0.125-0.25mg IV, maintenance dose0.125-0.25mg /day PO .
• Adverse reactions
− Fatigue, headache, blurred yellow or green vision, seizures
• Considerations
− Pregnancy safety: Category C
− Patient receiving IV digoxin must be on a monitor
− Assessment for renal function , serum K+, Mg++ level.
• Contraindications
− Ventricular fibrillation, ventricular tachycardia, digitalis toxicity
Diltiazem (Cardizem)Diltiazem (Cardizem)
• Classification :
• Calcium channel blocker, antianginal ,antihypertensive .
• Mechanism of action− Reduces myocardial oxygen
demand
• Indications− Controls rapid ventricular
rates(Paroxysmal supra ventriculartachycardia , atrial fibrillation , atrial flutter.
Dose :direct IV bolus :0.25mg/Kg (20mg for the average patient ) second bolus of 0.35mg /kg .
Continuous IV infusion 5-10 mg /hr
• Adverse reactions− Dizziness, weakness,
headache, dyspnea
• Considerations− Pregnancy safety: Category
C
− Use with caution in patients with renal or hepatic dysfunction.
• Contraindications− Hypotension
− Sick sinus syndrome
Dobutamine Hydrochloride (Dobutrex)
Dobutamine Hydrochloride (Dobutrex)
• Classification: Sympathomimetic ,Beta1 selective
adrenergic agonist.
• Mechanism of action− Increased myocardial
contractility, stroke volume, and increased cardiac output
• Indications− Cardiogenic shock, CHF
• Dose :Administer only by IV infusion using an infusion pump
• 2.5mg -10mg /kg/min IV is ususl rate to increase cardiac output .
• Adverse reactions
− Headache, dyspnea, tachycardia, hypertension, chest pain
• Considerations
− Pregnancy safety: Category B
− Monitor blood pressure
closely.
• Contraindications− Tachydysrhythmias, severe
hypotension
Dopamine Hydrochloride (Intropin)
Dopamine Hydrochloride (Intropin)
• Classification:
• Sympathomimetic
Alpha –adrenergic agonist , Beta1-selective adrenergic agonist, Dopaminergic drug .
• Mechanism of action− Increases myocardial
contractility and stroke volume
• Indications− Cardiogenic and septic
shock, hypotension with low cardiac output states
− Dose :Administer only by IV infusion using an infusion pump
− Initially 2-5mcg/kg/min IV patients who more seriously ill,5mcg/kg/min up to a rate of 20-50mcg/kg/min.
• Adverse reactions− Headache, anxiety,
dyspnea, dysrhythmias
• Considerations− Pregnancy safety: Category
C− Effects are dose-dependent
− Contraindications− Hypovolemic shock,
pheochromocytoma, tachydysrhythmias
Epinephrine (Adrenalin)
Epinephrine (Adrenalin)
• Classification: Sympathomimetic ,Alpha-adrenergic agonist,Beta1-and beta2- adrenegic agonist ,cardiac stimulant .
• Mechanism of action− Blocks histamine
receptors
• Indications− Cardiac arrest,
symptomatic bradycardia
• Dode:cardiac arrest ;0.5IV during resuscitation q 5 min.
• Adverse reactions− Nervousness, restlessness,
headache, tremor
• Considerations− Pregnancy safety: Category
C
− May cause syncope in asthmatic children
• Contraindications− Hypertension, hypothermia,
pulmonary edema
Furosemide (Lasix)
Furosemide (Lasix)
• Classification : loop diuretic
• Mechanism of action− Causes increased
urine output
• Indications− CHF, pulmonary edema,
hypertensive crisisDose: in pulmonary edema 40
mg IV over 1-2 min.may be increased to 80mg IV given over 1-2 min if response unsatisfactory after 1 hour .
in hypertension 40mg bid. if needed additional anti hypertensive may be needed .
• Adverse reactions− Dizziness, headache, ECG
changes, weakness
• Considerations− Pregnancy safety: Category
C
− Ototoxicity, deafness, and projectile vomiting can occur with rapid
administration.
• Contraindications− Hypovolemia, anuria,
hypotension
Haloperidol Lactate (Haldol)
Haloperidol Lactate (Haldol)
• Classification :
• Dopaminergic –blocking drug Antipsychotic.
• Mechanism of action
− Inhibits central nervous system catecholamine receptors
• Indications
− Acute psychotic episodes
Dose:IV unlabeled use for acute situations2-25mg IV q hr at arate of 5mg /min.
• Adverse reactions
− Seizures, sedation, confusion, restlessness
• Considerations
− Pregnancy safety: Category C
− Treat hypotension secondary to haloperidol with fluids and norepinephrine, not epinephrine
• Contraindications
− Parkinson's disease,
depressed mental status
Heparin SodiumHeparin Sodium
• Classification :Anticogulant
• Mechanism of action− Inhibiting thrombus and clot
formation by blocking the conversion of prothrombin to thrombin and fibronogen to fibrin plasmin; does not lyses existing clots
• Indications− Acute myocardial infarction,
prophylaxis and treatment of thromboembolic disorders
− Dose:Adjust dose according To cogulation tests. Dosage is
adequate when PTT=1.5-3 times control value .
• Adverse reactions− Pain, anaphylaxis, shock,
hematuria
• Considerations− Pregnancy safety: Category
C
− Heparin does not lyse
existing clots.
• Contraindications− Hypersensitivity, active
bleeding
Hydrocortisone Sodium Succinate (Solu-Cortef)Hydrocortisone Sodium Succinate (Solu-Cortef)
• Classification :• corticosteroid short
acting ,glucocorticoid ,Adrenal cortical steroid, hormone.
• Mechanism of action− Anti-inflammatory;
immunosuppressive with salt-retaining actions
• Indications− Shock due to acute
adrenocortical insufficiency, anaphylaxis, asthma, and COPD.
− Dose: 100mg- 500mg initially and q 2-10h based on condition and response .
• Adverse reactions− Headache, vertigo,
pulmonary tuberculosis
• Considerations− Pregnancy safety: Category
C
− May be used in status asthmaticus as a second-line drug
• Contraindications− Systemic fungal infections,
premature infants
Lidocaine Hydrochloride (Xylocaine)
Lidocaine Hydrochloride (Xylocaine)
• Classification: Antiarrhythmatic ,local anesthetic .
• Mechanism of action− Decreases automaticity of
ventricular cells , increase ventricular fibrillation threshold .
• Indications− Alternative to amiodarone in
cardiac arrest from ventricular tachycardia
− Dose :Arrhythmias, monitor ECG constantly ,give 50-100mg at rate of 25-50mg /min, 1/3 to 1/2the initial dose may be given after 5min if needed .do not exceed 200-300mgin 1 hr .
• Adverse reactions
− Anxiety, drowsiness, confusion, seizures
• Considerations
− Apnea induced with succinylcholine may be prolonged with high doses of lidocaine.
− Exceedingly high doses can result in coma or death.
• Contraindications
− Hypersensitivity, second- or third-degree AV block in the absence of an artificial pacemaker
Magnesium SulfateMagnesium Sulfate
• Classification:• Electrolyte Antiepileptic .
• Mechanism of action− Reduces striated muscle
contractions
• Indications− Seizures of eclampsia,
torsades de pointes, hypomagnesemia
• Dose:
• 1-4 gm of a 10%-20%solution .Do not exceed 1.5 ml/min of a10% solution. or 4-5 gm in 250ml of 5%dextrose. Do not exceed 3ml / min .
• Adverse reactions
− Drowsiness, CNS depression, respiratory depression
• Considerations
− Pregnancy safety: Category A
− Recommended that the drug not be administered in the 2 hours before delivery, if possible
• Contraindications
− Heart block, myocardial damage
Mannitol (Osmitrol)Mannitol (Osmitrol)
• Classification :
• osmotic diuretic, diagnostic agent,
• Mechanism of action− Decreases cerebral edema
and intracranial pressure
• Indications− Cerebral edema
• Dose:• In reduction of intracranial
pressure and cerebral edema:1.5-2 gm/kg as a 15%-25% solution over 30- 60min.Evidence of reduced pressure should be seen in 15 min.
• Adverse reactions− Headache, confusion,
seizures, pulmonary edema
• Considerations− Pregnancy safety:
Category C − May crystallize at low
temperatures; store at room temperature
− Have ventilatory support available.
• Contraindications− Hypotension,
pulmonary edema, severe dehydration, intracranial bleeding, CHF
Methylprednisolone Sodium Succinate (Solu-Medrol)
Methylprednisolone Sodium Succinate (Solu-Medrol)
• Classification:• corticosteroid,glucocorticoid ,
hormone.
• Mechanism of action− Suppresses acute and chronic
inflammation
• Indications− Acute spinal cord trauma,
anaphylaxis, bronchodilator for unresponsive asthma
• Dose:10-40mg IV administered over 1 min to several minutes .give subsequent dosesIVor IM.
• Warning :Rapid IV administration of large doses (more than0.5mg-1gm in less than 10-20min)has caused serious cardiac complications.
• Adverse reactions− Depression, euphoria,
headache, restlessness, seizure
• Considerations− Pregnancy safety:
Category C
− Not effective if time of spinal cord injury greater than 8 hours
• Contraindications− Premature infants, systemic
fungal infections
Midazolam Hydrochloride (Versed)
Midazolam Hydrochloride (Versed)
• Classification:• Benzodiazepine (short acting )
• CNS depressant
• Mechanism of action− Causes sedative, anxiolytic,
amnesic, and hypnotic effects
• Indications− Sedation for medical
procedures.− Continuous sedation of
intubated and mechanically ventilated patients during treatment in critical care setting .
• Adverse reactions− Headache, somnolence,
respiratory depression
• Considerations− Pregnancy safety: Category
D
− Administer immediately prior to intubation procedure.
• Contraindications− Acute narrow-angle
glaucoma, shock, coma, alcohol intoxication
Morphine Sulfate (Roxanol, MS Contin)
Morphine Sulfate (Roxanol, MS Contin)
• Classification: Opoid agonist analgesic .
• Mechanism of action
− Alleviates pain through CNS action
• Indications
− Severe CHF, acute cardiogenic pulmonary edema
Dose :2.5mg -15mg /70kg of body weight in 4-5ml water for injection administered over 4-5 min. Continuous IV infusion 0.1-1 mg /ml in 5% dextrose in water by controlled infusion device .
• Adverse reactions
− Confusion, sedation, headache, CNS depression
• Considerations
− Pregnancy safety: Category C
− Morphine rapidly crosses the placenta.
• Contraindications
− Head injury, exacerbated COPD, depressed respiratory drive
Naloxone Hydrochloride (Narcan)
Naloxone Hydrochloride (Narcan)
• Classification :
• Opoid antagonist , Diagnostic agent .
• Mechanism of action− Reverses respiratory
depression secondary to opiate drugs
• Indications
− Opiate overdose, complete or partial reversal of central nervous system and respiratory depression induced by opioids
• Dose: • Opoid overdose initial dose of
0.4 - 2 mg IV additional doses may be repeated at 2-3 min intervals. If no response after 10mg question the diagnosis .
• Contraindications− Use with caution in narcotic-
dependent patients
• Adverse reactions− Restlessness, seizures,
dyspnea, pulmonary
• Considerations− Pregnancy safety: Category
C
Nitroglycerin (Nitrostat, Nitro-Bid, Tridil)
Nitroglycerin (Nitrostat, Nitro-Bid, Tridil)
• Classification:
• Antianginal
• Mechanism of action− Smooth muscle relaxant
acting on vasculature, with a resultant decrease in venous return and decrease in arterial BP ,which reduces myocardial oxygen cosumption .
• Indications− Acute angina pectoris,
ischemic chest pain• Dose: Initial dose , 5mcg/min
delivered through an infusion pump .inceased by 5mcg/min .if no response
• 20mcg/min.Once BP response is obtained reduce dose and llengthen dosage intervals. continually monitor response and titrate carefully .
• Adverse reactions− Headache, dizziness,
weakness, reflex tachycardia
• Considerations− Pregnancy safety:
Category C − Hypotension more common
in the elderly
• Contraindications− Hypotension, hypovolemia,
intracranial bleeding or head injury
Norepinephrine Bitartrate (Levophed)
Norepinephrine Bitartrate (Levophed)
• Classification:• Sympathomimetic
• Alpha-adrenergic agonist ,Beta1adrenergic agonist , cardiac stimulant ,vasopresser.
• Mechanism of action− Potent alpha-agonist resulting
in intense peripheral vasoconstriction
• Indications− Cardiogenic shock,
unresponsive to fluid resuscitation
Dose :Add 4ml of the solution (1mg/ml)to 1000ml of 5% dextrose solution for a concentration of 4mcg base /ml
Initially give 8-12 mcg /min adjust dose gradually to maintain desired Bp .
• Adverse reactions− Headache, anxiety,
dizziness
• Considerations− Pregnancy safety: Category
C. − May cause fetal anoxia
when used in pregnancy
• Contraindications− Hypotensive patients with
hypovolemia
Ondansetron Hydrochloride (Zofran)
Ondansetron Hydrochloride (Zofran)
• Classification: Antiemetic
• Mechanism of action− Blocks action of serotonin
• Indications− Prevention and control of
nausea or vomiting
• Dose:• Prevention of chemotherapy -
induced nausea and vomiting three 0.15mg /kg doses IV first dose is given over 15 min, before 30min of starting the chemotherapy .
• Adverse reactions
− Headache, malaise, wheezing
• Considerations
− Pregnancy safety: Category B
• Contraindications− Known allergy to
ondansetron
OxygenOxygen
• Mechanism of action− Reverses hypoxemia
• Indications− Confirmed or
expected hypoxemia, ischemic chest pain
• Contraindications− Certain patients with
COPD will not tolerate oxygen concentrations over 35%.
• Adverse reactions− Decreased level of
consciousness (COPD patients), decreased respiratory drive in COPD patients
• Considerations− Be familiar with liter
flow and each type of delivery device used.
Phenytoin (Dilantin)
Phenytoin (Dilantin)
• Classification: • Antiepileptic , antiarrhythmic
group Ib.
• Mechanism of action− Promotes sodium
efflux from neurons− Effective in treating cardiac
arrhythmias, especially those induced by digitalis.
• Indications− Prophylaxis and treatment
of major motor seizures
Dose:status epilepticus 10-15 mg /kg
by slow IV .for maintenance 100mg 6-8 hr .
• Adverse reactions− Ataxia, agitation, dizziness,
headache, drowsiness
• Considerations− Pregnancy safety: Category
D
− Carefully monitor vital signs.
− Contraindications
− Hypersensitivity, bradycardia
Propofol (Diprivan)Propofol (Diprivan)
• Mechanism of action
− Produces rapid and brief state of general anesthesia
• Indications
− Anesthesia induction/ maintenance, sedation for mechanically ventilated patients
− Dose:Inducción anestésicaIV: 1 – 2,5 mg/kgMantenimiento anestésicoPerfusión IV: 50 – 150 mcg/kg/minSedaciónDosis de carga IV: 0,25 – 1 mg/kgMantenimiento IV: 10 – 50 µg/kg/min
• Adverse reactions
− Seizure, apnea, dysrhythmias, asystole, hypotension, hypertension
• Considerations
− Pregnancy safety: Category B
− Avoid rapid administration in elderly patients to avoid hypotension and airway obstruction.
• Contraindications
− Hypovolemia, known sensitivity
Propranolol Hydrochloride (Inderal)
Propranolol Hydrochloride (Inderal)
• Classification :• Beta-adrenergic blocker
(nonselective) antianginal,antiarrhythmic.
• Mechanism of action− Reduces chronotropic,
inotropic, and vasodilator response to beta-adrenergic stimulation
• Indications− Hypertension, angina
pectoris− Dose : life threatening
arrhythmias 1-3 mg IV with careful monitoring ,not to exceed 1mg /min .
• Adverse reactions− Weakness, depression,
fatigue, anxiety, dizziness, bronchospasm
• Considerations− Pregnancy safety:
Category C − Closely monitor patient
during administration.− Use with caution in elderly
patients.− Atropine should be readily
available.
• Contraindications− Sinus bradycardia, second-
or third-degree AV block
Sodium BicarbonateSodium Bicarbonate
• Classification :
• Electrolyte , systemic alkalinizer,
• Mechanism of action− Buffers metabolic acidosis
and lactic acid buildup
• Indications− Metabolic acidosis during
cardiac arrest.Dose:for severe metabolic
acidosis ,dose depends on blood CO2 content , PH, and patient clinical condition ,90-180mEq/L.IVduring first hour then adjust PRN.
• Adverse reactions
− Hypernatremia, metabolic alkalosis, tissue sloughing, cellulitis
• Considerations
− Pregnancy safety: Category C
− Repeat as needed in tricyclic antidepressant overdose until QRS narrows
• Contraindications
− Metabolic/respiratory alkalosis, hypokalemia, electrolyte imbalance
Tirofiban Hydrochloride (Aggrastat)
Tirofiban Hydrochloride (Aggrastat)
• Classification:
• Antiplatelet
• Mechanism of action− Inhibits aggregation of
platelets
• Indications− Acute coronary syndrome
• Dose:
• 0.4mcg/kg/min infusion over 30min .then continue at rate of 0.1 mcg/kg/min.
• Adverse reactions
− Dizziness, pain, sweating, intracranial bleeding, CVA
• Considerations
− Pregnancy safety: Category B
− Must be administered only with an infusion pump direct from bottle with a vented IV set
− Severe spontaneous bleeding risk
• Contraindications− Trauma or major surgery
within the past 30 days
IV Solutions (Colloids and Crystalloids)
IV Solutions (Colloids and Crystalloids)
• Colloids− Expand plasma volume
− Most often used in hypovolemic shock states
• Crystalloid solutions are used for:− Electrolyte replacement
− A route for medication
− Short-term intravascular volume expansion
DextranDextran
• Mechanism of action− Sugar-containing
colloid used as an intravascular volume expander
• Indications− Hypovolemic shock
• Contraindications− Patients with
congestive heart failure, renal failure, or known bleeding disorders
• Adverse reactions− Rash, itching,
dyspnea, chest tightness, and mild hypotension
• Considerations− In the management of
burn shock, it is especially important to follow standard fluid resuscitation regimens to prevent possible circulatory overload.
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